Provider Demographics
NPI:1508934225
Name:SPECTRACARE INC
Entity Type:Organization
Organization Name:SPECTRACARE INC
Other - Org Name:SAME AS ABOVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAGDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-772-5431
Mailing Address - Street 1:4750 N FEDERAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4609
Mailing Address - Country:US
Mailing Address - Phone:954-772-5431
Mailing Address - Fax:954-771-5722
Practice Address - Street 1:4750 N FEDERAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4609
Practice Address - Country:US
Practice Address - Phone:954-772-5431
Practice Address - Fax:954-771-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106872Medicare ID - Type UnspecifiedOUTPATIENT REHAB